Santoshi Ratnam K, Patel Reema, Patel Neil S, Bansro Varinder, Chhabra Gurdeep
Internal Medicine, Critical Care Medicine, and Anesthesia, Springfield Clinic, Springfield, USA.
Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA.
Cureus. 2022 Aug 5;14(8):e27718. doi: 10.7759/cureus.27718. eCollection 2022 Aug.
Thrombocytopenia is a common entity seen in ICU patients and is associated with increased morbidity such as bleeding and transfusions, and mortality in ICU patients. Various mechanisms such as decreased platelet production, sequestration, destruction, consumption, and sometimes a combination of these factors contribute to thrombocytopenia. An understanding of the mechanism is essential to diagnose the cause of thrombocytopenia and to help provide appropriate management. The management strategies are aimed at treating the underlying disorder, such as platelet transfusion to treat complications like bleeding. Several studies have aimed to provide the threshold for platelet transfusions in various clinical settings and recommend a conservative approach in the appropriate scenario. In this review, we discuss various pathophysiological mechanisms of thrombocytopenia and the diverse scenarios of thrombocytopenia encountered in the ICU setting to shed light on the varied thresholds for platelet transfusion, alternative agents to platelet transfusion, and future directions for the implementation of thromboelastography (TEG) in multiple clinical scenarios to assist in the administration of appropriate blood products to correct coagulopathy.
血小板减少症是重症监护病房（ICU）患者中常见的病症，与出血和输血等发病率增加以及ICU患者的死亡率相关。血小板生成减少、脾滞留、破坏、消耗等多种机制，有时这些因素的组合会导致血小板减少症。了解其机制对于诊断血小板减少症的病因以及帮助提供适当的治疗至关重要。治疗策略旨在治疗潜在疾病，如通过输注血小板来治疗出血等并发症。多项研究旨在确定各种临床情况下血小板输注的阈值，并建议在适当情况下采取保守方法。在本综述中，我们讨论血小板减少症的各种病理生理机制以及在ICU环境中遇到的血小板减少症的不同情况，以阐明血小板输注的不同阈值、血小板输注的替代药物，以及在多种临床情况下实施血栓弹力图（TEG）以协助给予适当血液制品来纠正凝血病的未来方向。
